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Reference  Htbrarp 


THE    DESTINY 


OF   THE 


American  Surgical  Association 


BY 


J.  EWING  MEARS,  M.D.,  LL.D. 

PHILADELPHIA 


REPRINTED   FROM  THE  TRANSACTIONS   OF   THE  ASSOCIATION 
VOL.   XXXV,   1917 


MAN 


WITH   THE  COMPLIMENTS 
OF  THE  AUTHOR 


That  each   thing,  both   in  small  and  in 
great,  fulfilleth  the  task  which  destiny  hath  set  down. 

Hippocrates. 


THE  DESTINY 


OF   THE 


AMERICAN  SURGICAL  ASSOCIATION 


A  few  years  ago  the  writer  read  before  this  Association  a 
paper  entitled,  "Reminiscences  of  the  Early  Days  of  the  Ameri- 
can Surgical  Association."1  He  was  moved  to  present  this  sub- 
ject for  the  consideration  and  thought  of  the  Fellows  at  that 
time  as  he  was  one  of  the  three  surviving  co-founders  out  of 
forty-eight  who  were  associated  with  the  Founder,  the  eminent 
Professor  Samuel  D.  Gross,  in  the  foundation  and  organization 
of  the  Association. 

By  reason  of  his  very  close  association  with  and  friendship 
for  the  Founder,  the  writer  felt  that,  more  than  any  other  of 
the  co-founders,  he  understood  and  appreciated  his  purposes 
and  intentions  in  founding  the  Association,  and  possessed 
knowledge  of  facts  which  would  be  of  interest  and  value  in 
recording  its  early  history. 

Many  of  these  facts  were  important  in  character  and  detail, 
as  they  had  relation  to  questions  closely  concerned  with  what 
was  esteemed  the  propriety  of  organizing  a  body  of  surgeons  of 

1  Tr.  Am.  Surg.  Assn.,  1908,  vol.  xxvi,  p.  15. 


4      MEARS:  DESTINY  OF  THE  AMERICAN  SURGICAL  ASSOCIATION 

the  country  which  might  be  hostile  to  the  welfare  of  the  Surgical 
Section  of  the  American  Medical  Association  and  interfere 
with  its  growth  and  development. 

The  Founder  was  a  distinguished  member  of  the  American 
Medical  Association,  and  from  its  earliest  days  had  taken  an 
active  interest  in  its  work,  had  received  its  high  honors,  had 
participated  especially  in  the  work  of  the  Surgical  Section, 
knew  of  its  needs  for  full  and  effective  development  and  appre- 
ciated the  difficulties  in  the  way  of  their  successful  accom- 
plishment. With  this  knowledge  and  with  his  extended  ex- 
perience as  the  great  teacher,  author,  and  practitioner,  which 
gave  him  acquaintanceship  and  understanding  of  the  profes- 
sional qualifications  and  position  of  the  members  of  the  medical 
profession  of  the  country  who  had  chosen  surgery  as  their  spe- 
cialty and  who  in  the  communities  in  which  they  resided  were 
known  as  practitioners  of  this  special  branch  of  medicine,  he  was 
prepared  to  treat  the  question  in  just  manner.  Where  medical 
institutions  existed,  these  distinguished  members  of  the  pro- 
fession had  become  teachers  and  authors,  had  gained  for  them- 
selves honorable  distinction,  and  their  names  and  reputations 
have  lived  in  the  history  of  medicine  of  our  country  among 
the  great  men  of  the  profession.  The  New  England  States, 
New  York,  Pennsylvania,  Ohio,  with  the  Middle  West,  the 
South,  with  Kentucky  in  the  forefront,  all  were  represented  in 
the  list  as  pioneer  surgeons  and  contributors  to  the  surgical 
history  of  the  country  which  in  several  instances  has  given 
it  distinction  the  world  over. 


MEARS:  DESTINY  OF  THE  AMERICAN  SURGICAL  ASSOCIATION      5 

Thus  equipped  the  Founder,  with  far-reaching  vision,  believed 
that  the  organization  of  an  independent  body  of  surgeons  would 
develop  the  work  of  the  Surgical  Section  of  the  Medical  Asso- 
ciation and  stimulate  its  growth;  would  perfect  the  contribu- 
tions of  its  members;  would  give  to  its  efforts  distinction  which 
it  had  not  possessed.  The  condition  of  the  Surgical  Section  of 
the  Medical  Association  today  verifies  the  prediction  of  the 
Founder  and  establishes  the  fact  that  he  correctly  understood 
its  needs  and  appreciated  to  the  fullest  extent  the  effect  the 
organization  of  the  American  Surgical  Association  would  have 
upon  it. 

In  founding  the  Surgical  Association  he  had  a  clear  percep- 
tion and  understanding  as  to  the  character  and  qualifications  of 
the  surgeons  from  the  different  parts  of  the  country  who  should 
constitute  its  Fellowship.  It  was  of  paramount  importance  that 
it  should  be  national  in  character,  through  which  plan  it  would 
bring  to  its  meetings  and  include  in  the  pages  of  its  volumes 
of  Transactions  the  surgical  work  characteristic  of  the  different 
portions  of  the  country,  influenced  as  it  would  inevitably  be 
by  modes  of  life  and  climate  and  topographical  conditions.  Its 
work  was  to  be  general,  not  special,  and  the  beginning  clauses  of 
its  Constitution  set  forth  clearly  the  object  or  purpose  of  its 
organization  and  the  qualification  of  those  who  should  be  eli- 
gible for  Fellowship.  To  give  knowledge  to  those  of  the  Fellows 
who  have  not  had  the  opportunity  of  reading  the  important 
organic  law  of  the  Association  and  to  refresh  the  memories  of 
those  who  may  not  have  cherished  its  terms  as  they  deserved, 


6      MEARS:   DESTINY  OF  THE  AMERICAN  SURGICAL  ASSOCIATION 

the   writer   transcribes   them   and    gives   them   place   in    this 
paper: 

"i.  The  object  of  the  Association  is  to  promote  the 
development  and  growth  of  surgical  science  and  the 
welfare  of  the  human  race. 

il2.  Candidates  eligible  for  election  as  Fellows  should 
have  made  some  reputation  as  author,  teacher,  prac- 
titioner or  original  investigator." 

The  By-laws  prescribed  the  manner  of  government.  The 
Fellowship  to  be  in  number  one  hundred,  and  a  limited  number 
of  Honorary  Fellows  to  be  chosen  from  the  eminent  surgeons  of 
this  country,  of  Great  Britain  and  the  continent  of  Europe. 
The  Code  of  Ethics  of  the  American  Medical  Association  was 
adopted  to  determine  the  proper  professional  standing  and  con- 
duct of  the  Fellows  of  the  Association.  The  Hippocratic  oath, 
to  which  each  graduate  in  medicine  subscribes  when  admitted 
to  its  ranks  as  members  of  the  medical  profession,  was  the 
pledge  of  fealty  offered  by  the  candidate  as  his  claims  for  approval 
of  the  Council  were  solicited.  Careful  examination  of  the  pro- 
fessional work  of  the  candidate,  with  study  of  his  contributions 
to  surgical  literature,  guided  the  Council  in  its  decision  as  to  his 
eligibility  for  admission  to  Fellowship  in  the  Association.  With 
this  scrutiny  of  the  Council  the  candidate  was  presented  to  the 
Association  for  its  suffrages.  Medical  politics  was  to  take  no 
part  in  deciding  the  result  of  the  ballot.  No  elaborate  ritual 
brought  the  successful  candidate  to  the  presence  of  the  presiding 
officer  and  Fellows.     Cap  and  gown  and  hood  did  not  adorn 


MEARS:  DESTINY  OF  THE  AMERICAN  SURGICAL  ASSOCIATION       7 

his  person  in  foreign  imitation — he  needed  no  such  artificial 
proclamation  of  his  merits — he  had  complied  with  the  require- 
ments of  the  organic  law  of  the  Association  and  was  pronounced 
by  the  Council  worthy  of  the  high  honor  to  be  bestowed  upon 
him  in  his  nomination  as  a  Fellow  of  the  Association — to  be 
ever  loyal  to  its  purposes  and  hostile  to  all  acts  of  degrada- 
tion of  its  integrity  as  the  exponent  of  surgical  science  of  our 
country. 

The  Association  thus  organized  was  prepared  to  begin  its 
work.  In  its  study  and  discussion  of  important  surgical  subjects 
awaiting  final  decision  it  was  intended  that  it  should  be  the 
court  of  last  resort.  A  Fellow  of  the  Association  was  appointed 
to  read  a  paper  on  a  subject  chosen  either  by  the  Association  or 
by  himself  and  a  number  were  appointed  to  discuss  the  paper 
presented.  In  this  manner  a  systematic  treatment  of  the  sub- 
ject could  be  obtained.  Today  the  method  employed,  while 
not  the  same  in  detail,  is  similar,  as  is  seen  in  the  program  of 
the  present  meeting.  The  grouping  of  various  subjects  having 
relation  to  the  one  which  is  principal,  invites  its  exhaustive 
discussion.  The  value  of  this  plan  of  treatment  is  unquestioned 
and  gives  it  a  completeness  which  could  not  be  otherwise 
obtained.  In  the  event  of  the  presentation  of  a  wide  field  of 
investigation  the  subject  could  be  considered  at  a  later  meeting 
and  the  information  gained  by  the  intervening  experience 
become  a  part  of  the  treatment  of  the  principal  subject.  To 
illustrate:  The  much-mooted  question  of  "Bony  Union  after 
Intracapsular  Fracture  of  the  Neck  of  the  Femur"  was  elabo- 


8      MEARS:  DESTINY  OF  THE  AMERICAN  SURGICAL  ASSOCIATION 

rately  treated  by  one  of  the  distinguished  Fellows  of  the  Asso- 
ciation at  a  second  meeting  of  the  Association.1  The  program 
of  the  meeting  today  announces  the  reading  of  a  paper  on  the 
same  subject  which  will  present  the  latest  knowledge  of  the 
subject,  the  result  of  study  and  experimental  investigation.  In 
this  way  a  solution  of  the  vexed  problem  may  be  reached. 

Also,  at  the  second  meeting,  a  paper2  was  read  which  recited 
the  results  of  experimentation  on  animals  to  determine  the 
possibility  of  the  employment  of  aseptic  ligatures  in  controlling 
hemorrhage  in  operations  involving  the  peritoneum  and  the 
organs  of  the  abdominal  cavity,  the  ligatures,  either  of  silk, 
silver  or  other  material,  which  might  be  regarded  as  a  foreign 
body,  to  be  permitted  to  remain  in  situ.  Before  this  time  it  was 
the  rule  to  apply  a  clamp  to  the  pedicle  in  ovarian  tumor  opera- 
tions and  fasten  it  between  the  edges  of  the  abdominal  incision 
in  order  to  avoid  hemorrhage.  Ligatures  applied  to  bleeding 
vessels  were  brought  out  of  the  cavity  with  the  pedicle  and 
removed,  when  sufficient  time  had  elapsed,  by  gentle  traction 
in  the  same  manner  as  in  amputation  operation  upon  the 
extremities.  The  result  of  experiments  which  were  made  showed 
on  examination  that  the  knot  of  the  ligature  became  encap- 
sulated and  in  this  condition  remained  in  situ  as  a  harmless 
body.  While  this  paper  recited  experimental  work  not  of 
great  magnitude  it  demonstrated  a  great  fact. 

1  Nicholas  Senn,  1881-83,  vol.  i,  p.  167. 

2  J.  Ewing  Mears:  The  Intraperitoneal  Method  of  Treating  the  Pedicle  in 
Ovariotomy,  with  a  Report  of  Some  Experiments  Made,  1881-83,  vol.  i,  p.  173. 


MEARS:  DESTINY  OF  THE  AMERICAN  SURGICAL  ASSOCIATION      0 

It  is  necessary  only  to  glance  at  the  titles  of  the  papers  printed 
on  the  program  of  this  year's  meeting  of  the  Association  to  com- 
prehend the  absolute  necessity  of  employing  this  form  of  liga- 
ture in  the  operations  there  recorded  —  operations  great  in 
variety  and  many  great  as  well  in  character  and  importance 
that  would  be  in  a  measure  impossible  of  performance  under 
the  older  methods. 

Still  further,  at  one  of  the  early  meetings  of  the  Association 
a  paper  on  neuralgia  of  the  inferior  dental  branch  of  the 
fifth  cranial  nerve,1  in  which  the  portion  in  the  inferior  dental 
canal  was  excised,  the  nerve  by  dissection  being  exposed  to  the 
foramen  through  which  the  main  trunk  emerges  from  the  cranial 
cavity  just  after  its  distribution  from  the  Gasserian  ganglion. 
The  dissection  made  in  the  operation  demonstrated  the  ability 
to  reach  the  ganglion  without  great  difficulty  and  induced  the 
operator  to  make  the  suggestion  that  inveterate  attacks  of 
trifacial  neuralgia  might  be  successfully  treated  by  removal  of 
the  Gasserian  ganglion.  This  suggestion  was  accepted  as  novel 
and  of  importance,  and  was  recorded  in  anatomical  and  surgical 
text-books  in  this  country  and  in  Europe,  the  American  Sur- 
gical Association  gaining  the  distinction  through  one  of  its 
Fellows,  and  its  volume  of  Transactions  was  given  importance  as 
the  book  of  reference.    It  has  promoted  the  treatment  of  trifacial 

1  J.  Ewing  Mears:  Study  of  the  Pathological  Changes  Occurring  in  Facial 
Neuralgia,  with  the  Report  of  a  Case  in  which  Three  Inches  of  the  Inferior 
Dental  Nerve  were  Excised,  1884,  vol.  ii,  p.  469.  Cure  of  Facial  Neuralgia, 
1896,  vol.  xiv,  p.  42. 


IO     MEARS:  DESTINY  OF  THE  AMERICAN  SURGICAL  ASSOCIATION 

neuralgia  by  surgical  procedures,  as  is  well  known.  The  program 
of  today's  meeting  contains  the  title  of  a  paper  which  may  be 
claimed  as  having  a  relation  to  the  suggestion  of  excision  of 
the  ganglion,  presenting  a  method  of  treatment  of  important 
value. 

In  this  brief  statement  the  attention  of  the  Fellows  is  directed 
to  the  work  of  the  Association  in  the  beginning  days.  It  fulfilled 
the  tests  of  eligibility  set  forth  by  the  founder,  among  them 
that  of  original  investigation;  it  showed  the  important  character 
of  the  subjects  chosen  for  study  and  development. 

In  the  thirty-seven  years  of  its  existence  the  Fellows  have 
dealt  with  the  great  problems  in  surgery;  have  labored  in  effec- 
tive manner  to  elucidate  the  great  principles  of  surgical  science, 
to  take  from  the  surgeon's  knife  the  bane  of  mutilation  and  give 
to  it  conservative  and  constructive  powers.  Laboratory  study 
has  claimed  the  unremitting  work  of  a  number  of  the  ablest 
and  most  distinguished  Fellows  of  the  Association  in  the  effort 
to  solve  the  vexed  problem  of  the  cause  and  treatment  of  the 
various  forms  of  malignant  disease.  Knowledge  of  this  subject 
grows  slowly  but  effectively.  In  the  near  future,  it  is  believed, 
the  problem  will  receive  a  true  solution  and  stop  the  ravages 
of  this,  thus  far,  unconquered  disease. 

In  my  paper  on  "Reminiscences  of  the  Early  Days  of  the 
Association"  attention  was  directed  to  the  part  the  Association 
took  in  the  organization  of  the  Congress  of  American  Physicians 
and  Surgeons.  Its  action,  accomplished  by  resolution  and  the 
formation  of  a  committee  to  meet  in  consultation  with  a  like 


MEARS:  DESTINY  OP  THE  AMERICAN  SURGICAL  ASSOCIATION      II 

committee  appointed  by  each  society  or  association  devoted  to 
the  cultivation  of  the  special  branches  of  medicine,  led  to  the 
formation  of  a  Congress  composed  of  separate  bodies,  a  meeting 
of  which  was  arranged  for  at  intervals  of  three  years.  A  central 
body  of  the  Congress  controlled  the  joint  meeting  of  the  sepa- 
rate bodies,  which  participated  without  the  loss  in  any  way  of 
their  autonomy.  The  value  of  the  meetings  of  the  Congress 
consists  in  most  important  manner  in  bringing  together  for 
scientific  work  and  social  intercourse  the  prominent  members 
of  the  medical  profession  devoted  to  the  study  and  practice  of 
the  special  branches  in  medicine  throughout  the  country.  Its 
purposes  are  of  a  high  order  and  its  work  has  given  distinction 
to  American  medicine.  The  successive  meetings  of  the  Congress 
have  demonstrated  the  value  of  such  organization,  and  the 
American  Surgical  Association  is  awarded  the  credit  of  its 
foundation. 

Approaching  two  score  years  of  work,  the  American  Surgical 
Association  can  point  with  becoming  pride  to  its  accomplish- 
ments. In  its  life  it  has  gathered  into  its  circle  of  Fellowship 
the  ablest  members  of  the  profession  of  medicine  in  Europe  and 
America.  Its  tests  for  Fellowship  were  set  high  and  the  door  of 
entrance  into  its  ranks  has  been  zealously  and  faithfully  guarded. 

A  distinguished  President  of  the  Association  in  his  inaugural 
address  gave  inspiring  character  to  its  Fellowship  in  the  state- 
ment that  "quality"  not  "quantity"  should  always  be  the  deter- 
mining factor  in  the  selection  of  those  who  should  constitute 
the  membership  of  the  Association. 


12      HEARS:  DESTINY  OF  THE  AMERICAN  SURGICAL  ASSOCIATION 

Its  thirty-four  volumes  of  Transactions  have  builded  a  glorious 
monument  of  scientific  surgical  work  which  has  made  lasting 
impression  on  the  study  and  practice  of  surgery  the  world  over. 
It  will  stand  forever  as  a  monument  to  the  far-reaching  vision  of 
the  great  Founder  of  the  Association. 

We,  who  control  its  work  today,  must  not  forget  the  great 
responsibility  which  rests  upon  us  to  preserve  intact  its  organi- 
zation; to  maintain  its  high  position  as  a  separate  and  indepen- 
dent body,  the  exponent  of  American  surgery;  to  remain  ever 
true  to  our  pledges  of  loyalty.  In  such  manner  the  destiny  of 
our  great  Association  will  be  fulfilled,  and  we,  with  those  who 
succeed  us,  inspired  by  like  devotion,  will  become  the  masters 
of  its  destiny. 


COLUMBIA  UNIVERSITY  LIBRARIES  (hsl.stx) 

RD  17  IV146  1917  C.I 


The  dest 


thp  American  Surgical  Ass 


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will 


